Impact of Transfer Status into a Comprehensive Stroke Center on Outcomes among Intra-Arterial Therapy Patients (P2.326)

Objective: To compare outcomes after intra-arterial therapy (IAT) among acute ischemic stroke (AIS) patients directly admitted versus transferred into a Comprehensive Stroke Center (CSC).Background: Clinical trials confirmed the benefits of IAT for managing AIS. However, not all hospitals are able to perform IAT, requiring rapid transfer of potential IAT candidates.Design/Methods: Data were retrospectively abstracted for AIS patients treated with IAT at a CSC (1/2014 - 5/2015) and two groups were compared: patients directly admitted to the CSC to those transferred in. The following outcomes were analyzed using stepwise logistic regression with adjustment for significant covariates (pu003c0.05): recanalization to TICI ≥2b, discharge and 90-day mRS (favorable, ≤2), sICH, and in-hospital mortality.Results: IAT was performed in 131 patients; 32 (24.4[percnt]) were directly admitted and 99 (75.6[percnt]) were transferred into the CSC. The median transfer distance was 27 miles (interquartile range 13-133). Transferred patients were significantly younger, more often male, with fewer comorbidities. Though CSC arrival to treatment was shorter in transfers (37 vs 72 minutes, pu003c0.001), the prolonged period between symptom onset and CSC arrival yielded an overall increased duration from symptom onset to treatment for transfers (288 vs 120 minutes, pu003c0.001). Pre-stroke locomotion, initial NIHSS score, IV-tPA use, and unadjusted outcomes were similar between groups. After adjustment, transfers were 82[percnt] less likely to have a favorable discharge mRS (OR=0.18, CI=0.05-0.60, p=0.01) than direct admits and a borderline unfavorable 90-day mRS (OR=0.32, p=0.08); no differences were observed for the remaining outcomes. In an analysis limited to patients treated within 6 hours after symptom onset, transfers still had a less favorable discharge mRS (OR=0.16, p=0.01).Conclusions: Directly admitted patients had more favorable discharge mRS scores than transferred patients treated with IAT at a CSC. This suggests select, potential IAT candidates may benefit from bypassing centers unable to perform IAT. Disclosure: Dr. Frei has received personal compensation for activities with Microvention, Covidien, Stryker, Siemens, and Penumbra as a consultant. Dr. Leonard has nothing to disclose. Dr. Jensen has nothing to disclose. Dr. Bellon has nothing to disclose. Dr. Whaley has received personal compensation for activities with Clinical Data Management/Neurobase and Genentech. Dr. McCarthy has nothing to disclose. Dr. Wagner has received personal compensation for activities with Genentech, Inc., as a speakers bureau member. Dr. Bar-Or has nothing to disclose.